The long-term objective of the current application is to reduce negative consequence with alcohol abuse by Native youth, through the development of effective, culturally relevant alcohol treatment programs. This research will be conducted in two phases. Phase I of the proposed research is devoted to program evaluation and treatment development activities. This Phase is necessary to lay the groundwork for the development of the two outpatient treatment programs to be included in the randomized clinical trail to be conducted in Phase II. The specific aims of Phase I are as follows: 1. Conduct a formative, summative, evaluation of existing alcohol and drug treatment programs available to urban American/Alaska Native adolescents at a community-based health center (the Seattle Indian Health Board). 2. Conduct an evaluation of an existing alternative- activities-based alcohol and drug prevention program (the Healthy Nations program) affiliated available to Native youth in the Seattle/King County area. 3. Assess diagnostic sensitivity/specificity of a brief screening instrument for identifying alcohol problems among Native youth in a primary care setting. 4. Evaluate existing measures of alcohol use, alcohol consequences, and hypothesized moderators and mediators of treatment and prevention efficacy, to assess cultural sensitivity of the items in a Native adolescent population 5. Develop and pilot-test Native adaptations of two promising outpatient group alcohol treatment programs (life-skills approach and a Native 12-step approach). The specific aims of phase II are I. Evaluate the overall and comparative efficacy of a life-skills outpatient alcohol treatment program (based on a skills-training, harm-reduction approach for a variety of lifestyle risk behaviors), as compared to a Native-oriented 12-step recovery and support program. 2. Assess individual differences that may be related to differential outcome, so as to inform future treatment matching efforts. 3. Disseminate information about effective programs to other Native communities. The specific aims of phase I will be accomplished through a formative/summative program evaluation, involving the baseline and three-month follow-up assessment of all referrals to existing services during the first year period, and all participants in prevention activities during this time period. In addition, treatment manuals will be developed and adapted for the population based on previously updated skills-training and 12-step programs, in collaboration with SIHB staff and including input from youth drawn from the existing service population. These programs will be pilot-tested and refined during Year 2 of the grant period. The specific aims of phase II will be accomplished through a randomized, controlled trial comparing the efficacy of the 12-step program with the life skills program. Both treatment programs will be provided and evaluated as outpatient treatment programs and as continuing care programs. 115 outpatients and 80 continuing care patients will participate in each of the two treatment conditions.